dengue outbreak

Dengue Mosquito Aedes aegypti

LAHORE, Dec 11: Manifesting their signature lethargy and casual attitude even in the face of one of the worst public health crises, the provincial health authorities ignored a vital diagnostic tool during the recent dengue epidemic which could have not only alerted the patients to the future risks but also added valuable back-up information to the official databank of the disease.

According to an official report, the recent outbreak has affected at least five per cent of the total population of the provincial capital.

Also available with Dawn, the report compiled on December 4 by epidemic control and investigation cell of Punjab health services directorate general, said some 592,899 people, including 571,302 suspected patients, from allover the province suffered from various forms of dengue fever during the recent epidemic.

Of the total number of the suspected patients, as many as 511,000 were reported in Lahore, besides 17,590 confirmed cases.

Interestingly, health department senior officials apparently misled the Punjab government by showing ‘ambiguous’ data which is evident from the fact that the report’ was based on the cases where only two simple modes of investigation — Immunoglobulin-G (IGG) and Immunoglobulin-M (IGM) – were employed.

Of all theses reported cases, 21,597 patients were diagnosed positive for the dengue only through IGG and IGM while the report totally missed the important and standard diagnostic tool called reverse transcription-polymerase chain reaction (RT-PCR), that may put at least 571,302 patients at grave risk if they contact the virus again as they were diagnosed only through simple CBC investigations.

These unsuspecting patients are not only at a grave risk of ignoring the precaution during the next dengue attack because of the incomplete diagnosis but their cases files would also be incomplete in case of recurrence of disease.

The world-renowned researchers, experts, and international health bodies like the World Health Organization (WHO) had sought observance of standard protocol during the dengue epidemic for diagnosing the sensitivity and specificity of the virus, mainly through the RT-PCR, NS1 Elisa and Lateral Flow Rapid Tests (LFRT).

“The CBC was an initial investigation usually conducted in almost all infectious diseases while the IGG, IGM was an indirect evidence,” an expert on dengue, Dr Masood Sheikh, told Dawn. So far the RT-PCR was the most reliable diagnostic tool which detected the virus’ exact volume by isolating the agent, he added.

During the recent epidemic, he said, the public sector hospitals adopted the case definitions of IGG and IGM antibody which was inadequate as these tests were only found positive for a specific number of days and time period during the disease.

Interestingly, this important investigation was available to the suspected patients at the Jinnah Hospital only.

The vast impact of the disease and application of simple CBC investigations on a large number of suspected patients in the
province to detect virus sketched a horrifying picture, showing how the authorities concerned ignored complete diagnosis of the disease despite the pre-outbreak warnings.

Similarly, like in the past, the authorities concerned took no interest in identification of the cerotype of the dengue virus that struck in the current epidemic.

Last year, researchers of a public health institution of the city carried out a study on the subject on their own. According to the study, which was also published in an internal journal of infectious diseases in USA during the epidemic of 2009 and 2010,
all four cerotype of dengue were present in Lahore.

According to the report, Lahore was on the top among Punjab districts where dengue affected no less than 511,000 people.

After Lahore, two other major cities — Faisalabad and Rawalpindi – were at the risk of the epidemic as the virus may shift
there in the coming season as shown by its past pattern.

Of the total patients reported all over the province, 21,597 people were tested positive for the virus so far, including 10 per cent of the health professionals like doctors, medical students, paramedics, nurses.

As many as 344 people succumbed to the disease, including a member provincial assembly, a senior bureaucrat, some doctors and a nurse during the current outbreak, the report said.

The report has also cited officially reported dengue cases in 36 other districts of the province, besides the federal capital, Islamabad.

About the public hospitals of provincial capital, the report said, Lahore General Hospital, Mayo Hospital and the Jinnah Hospital remained overstretched because of the huge influx of dengue patients.